Lifestyle changes are vital to prevent and treat hypertension, but patients and physicians frequently neglect them. If health behaviors are modified in a gradual and sustainable way, these personal changes in diet or exercise rarely cause side effects, make medications work more effectively, increase one’s sense of well-being, and have many health and mental health benefits beyond reducing high blood pressure.

As a 53-year-old with hypertension, Margaret wishes she could find a way to stop her two high blood pressure drugs, rather than start a third one.

But since her last doctor’s visit, her weight is up by 3 pounds to 218. Her blood pressure was 142/92 when last checked. She gets about six hours of sleep each night. Her ankle swelling interferes with her evening walks with her husband. She knows that many lifestyle factors contribute to her high blood pressure, but feels overwhelmed and doesn’t know where to start.

Changing behavior is a personal process, but several general principles can help Margaret and others:

Some people incorrectly believe that to be healthy, they must return to their weight in their teens or 20s. But in reality, modest weight loss can significantly reverse weight-related metabolic problems, including high blood pressure. The best advice is to:

Weigh yourself only once a week.

Learn to live with a small amount of hunger during the day.

Realize that setbacks are common and focus on long-term progress.

Sleep:
Overall, aim to get at least seven hours of high quality sleep per night.

It's a myth that you can make up for sleep deprivation by sleeping in on the weekends. In reality, any reduction in sleep can have unfavorable health effects. The best advice is to:

Adopt a regular schedule for sleep with no more than an extra hour on weekend days.

Stress:
As a long-term goal, incorporate at least 30 minutes of relaxation and contemplation into your day.

Stress is a natural reaction, but we are not powerless -- we can develop skills to cope with outside pressures and it is possible to react with resilience. The best advice is to develop a plan for incorporating this mental break. A variety of practices are beneficial, some choices include yoga, journaling, taking a relaxing walk outdoors or developing a mindfulness-based stress reduction practice.

The bottom-line is to take time to consider whether you’re on target with each of these five lifestyle goals. If not, reach out to your physician or other trusted resource to help develop a plan to take these important steps to improve your health.

Randall Stafford, MD, PhD, a professor of medicine and director of the Program on Prevention Outcomes and Practices, practices primary care internal medicine at Stanford. He is developing practical strategies to improve how physicians and consumers approach chronic disease treatment and prevention.